Sensibilidad y especificidad de las escalas diagnósticas en la apendicitis aguda. Estudio prospectivo / Sensitivity and specificity of the diagnostic scales in acute appendicitis. Prospective study

La Apendicitis Aguda se manifiesta cuando existe inflamación del apéndice cecal, representando una de las más notables causas de abdomen agudo con pronóstico quirúrgico en el mundo. Existen sistemas de puntuaciones que se han generado para su comprobación, mediante técnicas no invasivas, de fácil aplicación y reproducción; destacando entre ellas las escalas de ALVARADO, RIPASA, AIR, entre otras. Objetivo: Comparar la sensibilidad y especificidad de las escalas AIR Vs. RIPASA para el diagnóstico de la Apendicitis Aguda en el Hospital General Nacional "Dr. Ángel Larralde", período enero 2020 ­ diciembre 2022. Materiales: Estudio observacional, descriptivo y evaluativo, prospectivo y de corte transversal. Muestra fue intencional no probabilística, cumpliendo con los criterios de inclusión. Para la recolección de datos, se empleó la observación directa como técnica y como instrumentos las escalas AIR y RIPASA. Resultados: Muestra conformada por 192 pacientes, sin predisposición de géneros. Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica AIR: 70%; 58,33%; 73,68%; 53,84%; 65,62%; RIPASA: 88,88%; 42,85%; 66,66%; 75%; 68,75%. Conclusiones: La exactitud diagnóstica para la escala de RIPASA fue ligeramente mayor que para AIR (68,75% vs. 65,62%), permitiendo afirmar que, en el grupo de estudio, resultó más conveniente la aplicación de la escala de RIPASA en pacientes sanos para el diagnóstico correcto de Apendicitis Aguda(AU)

Acute Appendicitis manifests when there is inflammation of the cecal appendix, representing one of the most notable causes of acute abdomen with surgical prognosis in the world. There are scoring systems that have been generated for verification, using non-invasive techniques that are easy to apply and reproduce; highlighting among them the scales of ALVARADO, RIPASA, AIR, among others.Objective : To compare the sensitivity and specificity of the AIR Vs. RIPASA scales for the diagnosis of Acute Appendicitis at the National General Hospital "Dr. Ángel Larralde", period January 2020 ­ December 2022. Materials: Observational, descriptive and evaluative, prospective and cross-sectional study. Sample was intentional, non-probabilistic, meeting the inclusion criteria. For data collection, direct observation was used as a technique and the AIR and RIPASA scales as instruments.Results : Sample made up of 192 patients, with no gender predisposition. Sensitivity, specificity, positive predictive value, negative predictive value, and AIR diagnostic accuracy: 70%; 58.33%; 73.68%; 53.84%; 65.62%; RIPASE: 88.88%; 42.85%; 66.66%; 75%; 68.75%.Conclusions : The diagnostic accuracy for the RIPASA scale was slightly higher than for AIR (68.75% vs. 65.62%), allowing us to affirm that, in the study group, the application of the RIPASA scale was more convenient in healthy patients for the correct diagnosis of Acute Appendicitis(AU)

A comparative study of the RIPASA and Alvarado scores in geriatric patients diagnosed with acute appendicitis

SUMMARY OBJECTIVE: While abdominal pain is one of the most prevalent reasons for seeking medical attention, diagnosing elderly adults with acute appendicitis (AA) may be difficult. In this study, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado ratings were evaluated for diagnostic accuracy in patients who reported to the emergency department complaining of abdominal pain and received surgery for AA. METHODS: The data of patients over the age of 65 years who reported to the ER and had appendectomy after being diagnosed with AA were evaluated in this retrospective cohort study. For each patient, the diagnostic accuracy of the Alvarado and RIPASA scores was determined individually. RESULTS: A total of 86 patients were included in the research. The average patient was 71.2 years old, with a male preponderance of 46.5%. Alvarado's score was found to have an area under the curve (AUC) of 0.799, the Youden's index of 0.549, and a p-value of 0.001 after a receiver operating characteristic (ROC) study of the Alvarado score in identifying the diagnosis of AA. The AUC was 0.886 (95%CI 0.799-0.944), the Youden's index was 0.642, and a p-value of 0.001 was found in the ROC analysis of the RIPASA score in identifying the diagnosis of AA. CONCLUSIONS: When comparing the two scores used to diagnose AA, we found no statistically significant difference between the RIPASA and Alvarado scores (p=0.09), although the Youden's index for the RIPASA score was higher.

Escala RIPASA para el diagnóstico de apendicitis aguda en el Hospital "General Freyre de Andrade" / RIPASA scale for the diagnosis of acute appendicitis in the Hospital "General Freyre de Andrade"

RESUMEN Introducción: La escala RIPASA fue elaborada para el diagnóstico de apendicitis aguda y ha demostrado buena sensibilidad y precisión diagnóstica, sobre todo en poblaciones asiáticas. Objetivo: Determinar la utilidad de la escala RIPASA para el diagnóstico de la apendicitis aguda. Métodos: Estudio observacional, analítico y prospectivo con 70 pacientes ingresados y operados con diagnóstico presuntivo de apendicitis aguda en el Hospital "General Freyre de Andrade" entre septiembre de 2015 y diciembre de 2017. Resultados: El 91,4 por ciento de los casos presentaron apendicitis por diagnóstico histológico. El síntoma, el signo y el dato de laboratorio más frecuentes fueron el dolor en fosa ilíaca derecha (97,1 por ciento), el rebote positivo (100 por ciento), y la leucocitosis (87,1 por ciento), respectivamente. Las diferencias entre los casos con y sin apendicitis para la puntuación de la escala fueron estadísticamente significativas. Predominaron los casos con puntajes altos (62,8 por ciento). A los 7,5 puntos la sensibilidad fue de 94 por ciento, la especificidad de 33 por ciento, la razón de verosimilitud positiva de 1,41, la razón de verosimilitud negativa de 0,19, y la precisión diagnóstica de 88,6 por ciento. El área bajo la curva de Características Operativas del Receptor fue de 0,81. Conclusiones: La escala RIPASA tuvo una buena sensibilidad y una moderada razón de verosimilitud negativa que permitirían descartar casos negativos con puntuaciones bajas. También exhibió una precisión diagnóstica y un desempeño discriminativo general aceptable. Sin embargo, la pobre especificidad y muy baja razón de verosimilitud positiva la hacen poco útil como medio diagnóstico único para la apendicitis aguda(AU)

ABSTRACT Introduction: The RIPASA scale was developed for the diagnosis of acute appendicitis and has shown good sensitivity and diagnostic precision, especially in Asian populations. Objective: To determine the utility of the RIPASA scale for the diagnosis of acute appendicitis. Methods: Observational, analytical and prospective study with 70 patients admitted and operated on with a presumptive diagnosis of acute appendicitis at the Hospital "General Freyre de Andrade" between September 2015 and December 2017. Results: 91.4 percent of the cases presented appendicitis due to histological diagnosis. The most frequent symptom, sign and laboratory data were pain in the right iliac fossa (97.1 percent), positive rebound (100 percent), and leukocytosis (87.1 percent), respectively. The differences between the cases with and without appendicitis for the scale score were statistically significant. Cases with high scores predominated (62.8 percent). At 7.5 points the sensitivity was 94 percent, the specificity was 33 percent, the positive likelihood ratio was 1.41, the negative likelihood ratio was 0.19, and the diagnostic precision was 88.6 percent. The area under the Receiver Operating Characteristics curve was 0.81. Conclusions: The RIPASA scale had good sensitivity and a moderate negative likelihood ratio that would allow us to rule out negative cases with low scores. It also exhibited diagnostic accuracy and acceptable overall discriminatory performance. However, the poor specificity and very low positive likelihood ratio make it of little use as a single diagnostic means for acute appendicitis(AU)

Raja Isteri Pengiran Anak Saleha Appendicitis score for the diagnosis of acute appendicitis in comparison with the Alvarado score

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.

Respuesta del score RIPASA versus el histopatológico como predictor diagnóstico de apendicitis aguda en el Hospital Vicente Corral Moscoso año 2018 / Response of the RIPASA score versus the histopathology as a diagnostic predictor of acute appendicitis at the Vicente Corral Moscoso Hospital in 2018

Antecedentes: la Apendicitis Aguda (A.A) es una urgencia quirúrgica que requiere un diagnóstico y tratamiento oportuno. Muchas veces puede ser un gran reto para el cirujano por su relación con otras patologías, de allí la importancia de precisar su diagnóstico. Objetivo: validar la precisión diagnóstica del score RIPASA en apendicitis aguda comparándolo con el examen histopatológico. Metodología: se realizó un estudio de validación de pruebas diagnósticas con la información de 300 historias clínicas de pacientes apendicectomizados, atendidos en el Hospital Vicente Corral Moscoso durante el año 2018. Se evaluó mediante el score RIPASA al ingreso y se comparó con los resultados de histopatología como prueba gold standar. Se calculó la sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, además se obtuvo Odds Ratio con su IC al 95% para establecer la validez predictiva de esta escala. Resultados: la media de edad fue de 32 años ± 13,7 (DS), más de la mitad fueron: sexo femenino 52%, área urbana 74.7% y bachillerato 62.7%, predominó la etnia mestiza 99.7%. Hubo una asociación de riesgo entre una alta probabilidad de apendicitis según el score RIPASA con A.A (OR 96,36; IC95%: 16,03­578,68; p= 0,000). El score RIPASA tiene una sensibilidad de 98.97%, especificidad 50.0%, VPP 98.63%, VPN 57,14%, RVP 1.98% Y RVN 0.2%. Conclusiones: RIPASA tiene alta probabilidad para detectar a personas con apendicitis aguda, pero no así a las sanas, por lo cual se requiere continuar con más estudios para establecer tal validez

Background: Acute Appendicitis (A.A) is a surgical emergency that requires timely diagnosis and treatment. Many times it can be a great challenge for the surgeon because of its relationship with other pathologies, hence the importance of specifying its diagnosis. Objective: To validate the diagnostic accuracy of the RIPASA score in acute appendicitis by comparing it with the histopathological examination. Methodology: A study of validation of diagnostic tests was carried out with the information of 300 medical records of appendectomized patients, treated at the Vicente Corral Moscoso Hospital during 2018. It was evaluated by means of the RIPASA score at admission and compared with the histopathology results. as gold standard test. Sensitivity, specificity, positive predictive value, negative predictive value were calculated, in addition Odds Ratio was obtained with its 95% CI to establish the predictive validity of this scale. Results: The mean age was 32 years ± 13.7 (SD), more than half were: female 52%, urban area 74.7% and high school 62.7%, mixed race ethnicity predominated 99.7%. There was a risk association between a high probability of appendicitis according to the RIPASA score with A.A (OR 96.36; 95% CI: 16.03­578.68; p = 0.000). The RIPASA score has a sensitivity of 98.97%, specificity 50.0%, PPV 98.63%, NPV 57.14%, RVP 1.8% and RVN 0.2% Conclusions: RIPASA has a high probability of detecting people with acute appendicitis, but not healthy ones, so it is necessary to continue with more studies to find such validity

Efectividad de la Escala RIPASA para el diagnóstico de apendicitis aguda / Effectiveness of the RIPASA Score for the diagnosis of Acute Appendicitis

RESUMEN Introducción: La apendicitis aguda es la primera causa de atención quirúrgica en los servicios de urgencias de adultos en prácticamente todo el mundo, y la apendicectomía se ha establecido como el estándar de oro del tratamiento. Objetivo: Evaluar la efectividad de la escala RIPASA para el diagnóstico de apendicitis aguda. Métodos: Se desarrolló un estudio observacional-prospectivo de serie de casos en los pacientes con diagnóstico de apendicitis aguda a los que, se les aplicó la escala de RIPASA. Resultados: La escala de RIPASA presentó una efectividad del 90,38 por ciento de los casos estudiados con diagnóstico de apendicitis aguda. En la muestra obtenida, se encontraron 8 mujeres (5,13 por ciento) y 148 hombres (94,87 por ciento). Se evidenció una mayor representatividad en las edades entre 18 y 20 años. Conclusiones: Los sistemas clínicos de puntuación como, el usado en este estudio pueden ser una herramienta económica y de rápida aplicación en los servicios de urgencias para descartar la apendicitis aguda. Este sistema de puntuación es dinámico, lo que permite la observación y la reevaluación crítica de la evolución del cuadro clínico. Su aplicación mejora la precisión diagnóstica y, en consecuencia, reduce las apendicectomías negativas y la presentación de complicaciones(AU)

ABSTRACT Introduction: Acute appendicitis is the leading cause of surgical care in adult emergency services virtually worldwide. Appendectomy has been established as the gold standard of treatment. Objective: To evaluate the effectiveness of the RIPASA score for the diagnosis of acute appendicitis. Methods: An observational-prospective study of case series was carried out in patients diagnosed with acute appendicitis and who were applied the RIPASA score. Results: The RIPASA score showed an effectiveness of 90.38 percent of the cases studied with a diagnosis of acute appendicitis. The sample obtained consisted of eight women (5.13 percent) and 148 men (94.87 percent). Greater representativeness was evident in the ages between 18 and 20 years. Conclusions: Clinical scoring systems, such as the one used in this study, can be an inexpensive tool to be applied quickly in the emergency department to rule out acute appendicitis. This scoring system is dynamic, allowing critical observation and reassessment of the natural history of the condition. Its application improves diagnostic precision and, consequently, reduces negative appendectomies, as well as the onset of complications(AU)

Clinical Relevance of Modified Alvarado Score in Acute Appendicitis in Present Scenario

Introduction: Appendix is surely, the most commonlyharvested organ of the body. On looking up the literature,we found, that the negative appendectomy rates have beenconsistently maintained all through these years. Negativeappendectomy not only increases economic burden on healthcare facilities of a developing country like India, but alsohas a negative impact on the overall health of the patient.The following study was therefore, taken up to evaluate thediagnostic accuracy of the Modified Alvarado scoring systemand its ultimate effect on mortality and morbidity of the patient.Though this is an old score, but we restudied it, to revalidateas well as to promote the use of this simple, economicaland objective clinical score which actually uses establishedclinical methods, important for residents training program, toreach the diagnosis instead of the costly radiological methods.Material and methods: 50 patients presenting with thelower quadrant abdominal pain and fulfilling the inclusioncriteria were selected randomly and included in the study.Modified Alvarado Score was calculated for each one ofthem. Confirmation of the diagnosis was done after thehistopathological examination of appendix.Results: Modified Alvarado Score >7 was found in 80% (i.e.82.75% of males and 76.19% of females) of patients withappendicitis. In addition to these findings, we also got exactinformation about the age and sex distribution along withthe most common presenting complaint, the postoperativecomplications and the need for post operative stay inappendicitis patients.Conclusion: Modified Alvarado Score is a fast, simple,noninvasive, repeatable and highly economical score. Whenapplied purposefully and objectively, it can prevent delayin surgeries and hence complications as well as can reducenegative appendectomies.

Aplicación de la escala RIPASA en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda / The application of the RIPASA scoring system to the clinical files of patients discharged with a diagnosis of acute appendicitis

Introducción: la apendicitis aguda es la enfermedad que mayores cirugías de urgencia demanda en el mundo. Objetivo: establecer la efectividad diagnóstica de la escala RIPASA (Raja Isteri Pengiran Anak Saleha Apendicitis) en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda. Método: se realizó un estudio transversal de evaluación de pruebas diagnósticas en un universo de 271 historias clínicas de pacientes con diagnóstico al egreso de apendicitis aguda, en los Hospitales Carlos Manuel de Céspedes y Celia Sánchez, Granma. El criterio de inclusión fue la descripción de cada uno de los reactivos de la escala en dichas historias. Se aplicó la escala de RIPASA. Los datos se procesaron en el sistema SPSS 21 versión. Resultados: la edad media de los pacientes fue de 31,79 años predominando el sexo masculino (56,83 por ciento). Del total de pacientes, 98,15 por ciento de los pacientes tuvieron un diagnóstico histológico de apendicitis aguda; 54,98 por ciento resultaron con alta probabilidad de apendicitis aguda, mientras que 29,89 por ciento resultaron en diagnóstico de apendicitis aguda según la escala. El análisis de los resultados de la escala RIPASA arrojó una sensibilidad de la escala del 87 por ciento. Conclusiones: la escala RIPASA demostró valores de sensibilidad diagnóstica en población cubana, acorde a lo reportado en la literatura. Se recomienda su utilización en el diagnóstico de apendicitis aguda(AU)

Introduction: Acute appendicitis is the illness demanding the greatest amount of surgeries worldwide. Objective: To establish the diagnostic effectiveness of the RIPASA scoring system in the clinical files of patients discharged with a diagnosis of acute appendicitis. Method: A cross-sectional study of assessment of diagnostic test was performed in a universe of 271 clinical files of patients with discharge after diagnosis of acute appendicitis in Carlos Manuel de Céspedes Hospital and Celia Sánchez Hospital of Granma Province. The inclusion criterion was the description of each reagent of the scoring system in this files. The RIPASA scoring system was applied, and the data were processed in the system SPSS version 21. Results: The patients' average age was 31.79 years, with a prevalence of the male sex (56.83 percent). 98.15 percent of the patients had a histological diagnostic of acute appendicitis. 54.98 percent of the patients presented high probability of acute appendicitis, while 28.89 percent of them had a diagnosis of acute appendicitis based on the scoring system. The analysis of the results of the RIPASA scoring system produced a scale sensibility at 87 percent. Conclusions: In the Cuban population, the RIPASA scoring system showed values of diagnostic sensibility consistent with what is reported in the scientific literature, a reason why its use is recommended for the diagnosis of acute appendicitis(AU)

Comparación entre los scores de Ripasa y Alvarado modificado en el diagnóstico de apendicitis aguda, 2015-2016 / Comparison between the scores of Ripasa and Alvarado modifieed in the diagnosis of acute appendicitis, 2015-2016

Objetivo: Determinar que score tiene mayor sensibilidad y especificidad entre el de RIPASA y el de ALVARADO modificado para corroborar el diagnóstico de Apendicitis Aguda en pacientes de 16 a 60 años de edad, Hospital Regional de Ica del 1 de octubre del 2015 al 30 de setiembre del 2016. Material y Metodos: Se realizó un estudio descriptivo, transversal y retrospectivo de 150 historias, se apoyo con los programas estadístico SPSS V 22.0; Microsoft Word 2013 y Microsoft Excel. Resultados: La sensibilidad, especificidad, VPP y VPN del score de RIPASA fue 88,7%, 77,8%, 98,4% y 30,4% respectivamente (para un score ≥ 7,5) y para el score de Alvarado fue 71,6%, 77,8%, 98,1% y 14,9% respectivamente (para un score ≥ 7), El área bajo la curva ROC del score de RIPASA fue de 0.848, superior a la de Alvarado de 0.81.Conclusiones: La efectividad diagnóstica del score de RIPASA fue 84.8% y del score de Alvarado Modificado de 81%, demostrando mayor exactitud como prueba diagnóstica. (AU)

Objetive: To determine which score has greater sensitivity and specificity between RIPASA and modified ALVARADO to corroborate the diagnosis of acute appendicitis in patients 16 to 60 years of age, Regional Hospital of Ica from October 1, 2015 to September 30 2016. Material And Methods: We carried out a descriptive, transversal and retrospective study of 150 histories, supported with the statistical programs SPSS V 22.0; Results: The sensitivity, specificity, VPP and NPV of the RIPASA score were 88.7%, 77.8%, 98.4% and 30.4%, respectively (for a score ≥ 7.5) And the Alvarado score was 71.6%, 77.8%, 98.1% and 14.9%, respectively (for a score ≥ 7). The area under the ROC curve of the RIPASA score was 0.848, higher To that of Alvarado of 0.81.Conclusions: The diagnostic effectiveness of the RIPASA score was 84.8% and the modified Alvarado score was 81%, demonstrating greater accuracy as a diagnostic test. (AU)

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis / 世界急诊医学杂志（英文）

@#BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

Precisión diagnóstica de la escala RIPASA para el diagnóstico de apendicitis aguda: análisis comparativo con la escala de Alvarado modificada / Diagnostic accuracy of the RIPASA Score for the diagnosis of acute appendicitis: comparative analysis with the modified Alvarado Score

Objetivo: Evaluar en forma comparativa la escala de Alvarado modificada y la escala RIPASA, para conocer su utilidad en el diagnóstico de apendicitis aguda en un hospital de tercer nivel de atención del sector salud. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, comparativo y observacional. Análisis estadístico: Medidas de tendencia central, análisis para pruebas diagnósticas (sensibilidad, especificidad, valores predictivos, likelihood ratio o coeficiente de probabilidad) y curva ROC. Pacientes y métodos: De acuerdo al cálculo de tamaño de muestra se estudiaron 70 pacientes, que ingresaron al Servicio de Urgencias del Hospital General de México con síndrome doloroso abdominal sugestivo de apendicitis aguda, se les realizaron estudios de laboratorio y gabinete. Aplicando en forma simultánea las escalas de Alvarado modificada y la RIPASA. Se anotaron hallazgos clínicos, quirúrgicos e histopatológicos del apéndice. Resultados: La escala de Alvarado presentó una sensibilidad de 89.5% y especificidad de 69.2%, la RIPASA presentó una sensibilidad de 91.2% y especificidad de 84.6%. El área bajo la curva ROC de la escala RIPASA fue de 0.93, superior a la de Alvarado de 0.89. Si la decisión quirúrgica se hubiera realizado con base en la escala de Alvarado, las apendicectomías negativas se hubieran presentado en 18.3% pacientes, y con RIPASA disminuirían a 15.7%. Conclusiones: Ambas escalas presentaron buena sensibilidad para el diagnóstico de apendicitis aguda. La escala RIPASA presentó mejor especificidad y valores predictivos, con menor probabilidad de apendicectomías negativas. La escala RIPASA presenta mayor exactitud diagnóstica que la de Alvarado.

Objective: To assess comparatively the Modified Alvarado and the RIPASA scores, to know their usefulness in the diagnosis of acute appendicitis in a third level health care hospital. Setting: General Hospital of Mexico. Design: Prospective, cross-sectional, comparative, and observational study. Statistical analysis: Central Tendency Measures, analyses for diagnostic tests (specificity, sensitivity, predictive values, likelihood ratio) and ROC curve. Patients and methods: According to the established sample size, we studied 70 patients that were admitted at the Emergency Ward of the General Hospital of Mexico, with abdominal pain syndrome suggestive of acute appendicitis. Laboratory and imaging studies were performed. The modified Alvarado and RIPASA scores were applied simultaneously. Clinical, surgical, and histopathological findings were recorded. Results: The Alvarado score presented a sensitivity of 89.5% and a specificity of 69.2%, whereas RIPASA presented a sensitivity of 91.2% and specificity of 84.6%. The area under the ROC curve for the RIPASA score was 0.93, higher than that of the Alvarado with 0.89. If surgical decision had been based on the Alvarado score, negative appendicectomies would have been encountered in 18.3% of patients, and with RIPASA they would have diminished to 15.7%. Conclusions: Both scores presented a good sensitivity for the diagnosis of acute appendicitis. RIPASA presented better specificity and predictive values, with a lower likelihood of negative appendicectomies. The RIPASA score had a better diagnostic accuracy than the Alvarado score.